Prenatal alcohol use by women is the most frequent and preventable known cause of mental retardation and birth defects in the United States. Although most women who drink abstain from alcohol after learning they are pregnant, 10 percent to 20 percent continue to drink during pregnancy and many will return to levels of alcohol intake after delivery that place their next pregnancy at risk. Brief motivational interventions to encourage women to change their prenatal alcohol use have the potential to prevent alcohol-related injury to the fetus in the current and subsequent pregnancies. The specific aims of this randomized, controlled, single-blinded, study are to: 1) assess the effect of brief motivational interventions on the alcohol intake of women during pregnancy and at 12 months postpartum, 2) assess how readiness to change and self-efficacy for change moderate or mediate the relationship between brief intervention and alcohol use, 3) identify maternal and intervention factors that predict drinking behaviors and mediate the effect of brief intervention, and 4) determine in what way the knowledge, attitudes, and beliefs of the significant other (male partner, family member, or friend) affect maternal alcohol use following intervention. The primary hypothesis of this study is that, compared to usual care, women randomized to the brief intervention group will be more likely to abstain or to significantly decrease alcohol intake during pregnancy and at 12 months postpartum. Pregnant women presenting for their first prenatal clinic visit will be screened for alcohol use. Four hundred twenty-eight protocol-eligible subjects will be enrolled over an 18-month period and randomized to usual care or to brief intervention. Subjects in the brief intervention arm will meet with a nurse therapist for motivational interviews at time of enrollment, 4 and 8 weeks later, and at 6 weeks postpartum. The significant others of study subjects in the intervention arm will be given brief telephone advice on supporting healthy prenatal drinking behaviors at baseline and at 6 weeks postpartum. Research assistants who are blinded to treatment assignment will perform telephone assessments at 6 and 12 months postpartum, and in-person assessments of the study subject and newborn infant at delivery. The primary study outcome measure will be alcohol use during pregnancy and at 12 months postpartum. If proven effective, this type of intervention could be broadly implemented as a method to decrease the incidence of fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental defects. This study will also provide valuable data on maternal and social factors that influence the effect of brief interventions and on which components of a brief intervention are most crucial for producing behavioral change in this population.